SPECTRUM MEDICAL GROUP, P.A. (NPI# 1588687586) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588687586 |
| Entity Type | Organization |
| Organization Name | SPECTRUM MEDICAL GROUP, P.A. |
| Other Organization Name | SOUTHERN RADIOLOGY ASSOCIATES OF MAINE |
| Practice Address |
140 Academy St Presque Isle ME 04769-3102 |
| Mailing Address |
482 Congress St Portland ME 04101-3493 |
| Practice Telephone | 2077684217 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-10-31 |
| Authorized Official Name | DAVID B. LANDRY (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 2078835295 |
| Is Organization Subpart | Y |
| Parent Organization Name | SPECTRUM MEDICAL GROUP, P.A. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0203X |
Radiology Specialization: Therapeutic Radiology |
Allopathic & Osteopathic Physicians | ||
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ME | AETNA NON-PHO | 1044567 | 01 |
| ME | CIGNA | M108750 | 01 |
| ME | ANTHEM | S0527 | 01 |
| ME | AETNA PHO | 2547081 | 01 |
| ME | ANTHEM | S0528 | 01 |
| NH | 30010301 | 05 |
| Other Name | Type Code |
|---|---|
| Southern Radiology Associates of Maine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174050025 | Spectrum Medical Group, P.a. | Clinic/Center | 100 Griffin Rd, Portsmouth, NH 03801-7158 | 2017-05-22 |
| 1841722618 | Spectrum Medical Group, P.a. | Surgery | 10 Andover Rd, Portland, ME 04102-1954 | 2017-03-31 |
| 1639577620 | Spectrum Medical Group, P.a. | Radiology | 489 State St, Bangor, ME 04401-6616 | 2014-12-08 |
| 1003213208 | Spectrum Medical Group, P.a. | Anesthesiology | 489 State St, Bangor, ME 04401-6616 | 2014-12-03 |
| 1821495029 | Spectrum Medical Group, P.a. | Physical Medicine & Rehabilitation | 489 State St, Bangor, ME 04401-6616 | 2014-12-03 |
| 1801140660 | Spectrum Medical Group, P.a. | Psychiatry & Neurology | 498 Essex St, Suite 105, Bangor, ME 04401-3990 | 2012-11-01 |
| 1265794655 | Spectrum Medical Group, P.a. | Physical Medicine & Rehabilitation | 77 Bates St, Suite 102, Lewiston, ME 04240-7637 | 2012-06-12 |
| Street Address |
140 ACADEMY ST |
| City | PRESQUE ISLE |
| State | ME |
| Zip Code | 04769-3102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063415123 | Roy Frieband | Family Medicine | 140 Academy St, Presque Isle, ME 04769-3102 | 2005-05-23 |
| 1851900971 | Georgina Aguirre | Nurse Practitioner | 140 Academy St, Presque Isle, ME 04769-3171 | 2020-07-24 |
| 1144840570 | Angel Hebert | Dietitian, Registered | 140 Academy St, Presque Isle, ME 04769-3102 | 2020-04-27 |
| 1265052716 | Benjamin Mayhew | Dietitian, Registered | 140 Academy St, Presque Isle, ME 04769-3102 | 2020-04-24 |
| 1184253247 | Thomas Merrow | Dietitian, Registered | 140 Academy St, Presque Isle, ME 04769-3102 | 2020-04-02 |
| 1497395511 | Danielle Desjardins | Nurse Practitioner | 140 Academy St, Presque Isle, ME 04769-3102 | 2020-01-07 |
| 1598302309 | Elizabeth Cole | Registered Nurse | 140 Academy St, Presque Isle, ME 04769-3102 | 2019-11-30 |
| 1720638950 | Lindsay Ireland | Nurse Practitioner | 140 Academy St, Presque Isle, ME 04769-3102 | 2019-09-19 |
| 1902468671 | Jessica Rossignol | Nurse Practitioner | 140 Academy St, Presque Isle, ME 04769-3102 | 2019-07-02 |
| 1093378002 | Shea Gabriella Craig | Occupational Therapist | 140 Academy St, Presque Isle, ME 04769-3102 | 2019-04-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871088070 | Hong Na Yang | Dentist | 122 Academy Street, Presque Isle, Presque Isle, ME 04769 | 2018-06-29 |
| 1588185409 | Dwight David Hubacher | Physical Therapy Assistant | 162 Academy Strret, Presque Isle, ME 04769 | 2017-06-30 |
| 1831561562 | Vna Home Health & Hospice | Home Health | 18 Green Hill Rd Ste 1, Presque Isle, ME 04769 | 2015-10-21 |
| 1225439581 | A & L Clinical Services | Community/Behavioral Health | 742 Main Street, Presque Isle, ME 04769 | 2014-09-05 |
| 1568728343 | Enrique Octavio Bujanda-morun | Surgery | Ar Gould Hospital 140 Academy St, Presque Isle, ME 04769 | 2012-04-06 |
| 1669659603 | Susan Cambridge Dick | Occupational Therapist | 10 Bernadette, Caribou Rehab and Nursing Center, Caribou, ME 04769 | 2008-01-22 |
| 1285826792 | Osama Aziz | Internal Medicine | 146 Academy St, Suite 1b, The Aroostook Medical Center, Presque Isle, ME 04769 | 2007-08-17 |
| 1831220250 | Rachel Mary Swartz | Obstetrics & Gynecology | 140 Academy St Ste 4, Presque Isle, ME 04769 | 2007-03-08 |
| 1114053634 | Ralph U Scheidler | Social Worker | 20 Dyer Street, Community Care, Presque Isle, ME 04769 | 2007-02-26 |
| 1427158716 | Venkatram Nethala | Internal Medicine | 146 Academy Street, Suite 1b, Presque Isle, ME 04769 | 2006-09-25 |
| Find all providers in zip 04769 | ||||
| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770591588 | John R. Mullen | Radiology | 140 Academy St, Presque Isle, ME 04769-3102 | 2006-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356900328 | Susan Tyler | Radiology | Grant 6 489 State St, Bangor, ME 04401-6616 | 2019-06-12 |
| 1477561207 | Jeffrey A. Young | Radiology | 111 Greely Rd, Cumberland, ME 04021-3800 | 2006-08-04 |
| 1144238726 | Stuart G. Gilbert | Radiology | 1 Spruce Ln, Falmouth, ME 04105-1196 | 2006-08-03 |
| 1053360891 | Peter M Lambert | Radiology | 33 Whiting Hill Rd Ste 1, Brewer, ME 04412-1004 | 2006-05-09 |
| 1477538304 | Kurt Matthew Snyder | Radiology | 33 Whiting Hill Rd, Suite 1, Brewer, ME 04412-1021 | 2005-12-14 |
| 1073908505 | Whitney Beeler | Radiology | 22 Bramhall St, Portland, ME 04102-3134 | 2015-04-01 |
| 1235536319 | Northeast Radiation Oncology Pa | Radiology | 33 Whiting Hill Rd, Brewer, ME 04412-1021 | 2014-12-04 |
| 1063708097 | Janeen Daniels | Radiology | 33 Whiting Hill Rd, Brewer, ME 04412-1021 | 2011-06-28 |
| 1215228614 | Julian A Johnson | Radiology | 22 Bramhall St, Portland, ME 04102-3134 | 2011-04-20 |
| 1326363714 | Matthew David Cheney | Radiology | 22 Bramhall St, Portland, ME 04102-3134 | 2010-03-29 |
| Find all providers with the same taxonomy | ||||
| City | PRESQUE ISLE |
| Zip Code | 04769 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.